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Behavioural Problems - Psychiatry > Psychosexual disorders > Flashcards

Psychosexual disorders Flashcards

1
Q

What are the three types of sexual disorder?

A

disorders of sexual preference, gender identity disorders, sexual dysfunctions

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2
Q

What problems do you get in both male and female

A

Reduced libido, arousal difficulties, reaching orgasm too soon, failure to orgasm, dyspareunia

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3
Q

what is lack or loss of libido?

What are the different types

A

Lack or loss of sexual desire
• Lack of pleasure in anticipating, or reduced urge in engaging in, sexual activity

• Primary (always been absent) → secondary (declined) → situation (settings or partner) → OR total

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4
Q

Treatment for loss of sexual desire

A

Rx: treat primary cause (if found), couple therapy (relationship issues), graded individual exercises

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5
Q

Signs of sexual aversion or lack of sexual enjoyment

A
  • Strong –ve feelings, fear or anxiety due to prospect of sexual interaction
  • Active avoidance of sexual activity
  • Lack of enjoyment → lack of pleasure, despite normal sexual responses + achievement of orgasm
  • Can stem from rape/molestation
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6
Q

What is excessive sexual desire related to and what is the treatment

A
  • Nymphomania (women)
  • Satyriasis (men)
  • Can be secondary to mood disorder (mania), early stages of dementia, learning disability, brain injury, SE drugs
  • Rx: treat primary problem, CBT
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7
Q

Psychosexual problems specific to females, and which is most common

A

Failure of genital response
Orgasmic dysfunction (most common)
Non-organic vaginismus
Non-organic dyspareunia

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8
Q

what is failure of genital response in females and what is the treatment

A
  • Usually due to vaginal dryness or lack of lubrication, psychological factors (anxiety), physical (infection), oestrogen def. (post-menopausal), secondary to lack/loss of sexual desire
  • Rx → ↑ arousal levels, alleviate dryness (lubricant, oestrogen replacement)
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9
Q

What is orgasmic dysfunction in females and what is the treatment

A
  • MOST COMMON sexual complain in women
  • Delayed or doesn’t occur despite normal sexual arousal + excitement
  • Primary → never had orgasm
  • Secondary
  • Situational
  • Or total (all situations)
  • Rx → specialist sex specialist referral, directed self-help programme (‘sensate focus’ for couples, kegel’s pelvic floor exercises…etc)
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10
Q

What is non-organic vaginismus

A
  • Penetration impossible or painful due to blockage of vaginal opening (spasms of pelvic floor muscles)
  • Related to anxiety + fearful thoughts (e.g. fear of penetration pain, previous sexual assault..etc)
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11
Q

Treatment non organic vaginismus

A 
Rx
o	Vaginal examination → look for obstruction
o	Education (dispel myths about sex), relaxation techniques, strategies to achive penetration (kegel’s exercise, graded trainers [small → big]), involvement of partner…etc
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12
Q

What is non-organic dyspareunia

A

Pain during intercourse (superficial or deep)

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13
Q

Treatment for non-organic dyspareunia

A

o Exclude physical causes → infection, tender epiotomy scar, endometriosis, ovarian cyst
o Relaxation techniques (e.g. Kegel’s exercise)

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14
Q

DDx non-organic dyspareunia

+ treatment for this

A

PELVIC CONGESTION SYNDROME (if pain felt after intercourse) – a chronic medical condition in women caused by varicose veins in the lower abdomen - blood accumulation during arousal w/out orgasm (Rx: stimulate orgasm → e.g. vibrator)

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15
Q

Psychosexual problems specific to men

A

Erectile failure
Orgasmic dysfunction
Premature ejaculation
Non-orgasmic dyspareunia

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16
Q

What is erectile failure and what are contributing factors

A
  • Inability to develop or maintain an erection, leading to failure of sexual intercourse
  • Contributing factors: moral/religious views on sex/masturbation, previous –ve sexual experiences, performance anxiety, alcohol/drugs, stress, fatigue
17
Q

Treatment of erectile failure

A

education (factors), self-help exercises, sildenafil (Viagra), papaverine or PG E1 (training on self-insertion), vacuum constriction device, surgical implant inflatable penis prosthesis

18
Q

Orgasmic dysfunction men - what is it and treatment

A
  • Inhibited ejaculation
  • Rx: reduce performance anxiety, ↑ arousal + physical stimulation, addressing triggers/relationship problems/memories of past traumatic events…etc, education (dispel myths, effects of alcohol), sensate focus
19
Q

What is premature ejaculation? What is the DDx?

What is the rx?

A
  • Inability to control ejaculation adequately for both partners to enjoy the sexual interaction
  • DDx → sexually inexperienced men, psychological stress, organic impairment (esp. pain), delayed erection
  • Rx → education, reduce performance anxiety, self-help guides, exercises (‘stop-start’ technique and ‘squeeze’ technique), sensate focus
20
Q

Non-orgasmic dyspareunia - men

Causes and treatment

A
  • Pain during intercourse in men
  • Causes: physical (urethral infection, scarring secondary to STD, tight foreskin), psychological
  • Rx: treat physical, treat psychological (reassurance, education, relaxation techniques)
21
Q

Define transexualism

A

a disorder of gender identity characterised by the desire to live and be accepted as a member of the opposite sex (usually accompanied by a sense of discomfort w/ one’s anatomical sex)

22
Q

Define sex

A

the anatomy of a person’s reproductive system + their secondary sexual characteristics

23
Q

Define gender

A

personal awareness of one’s own gender based on internal awareness

24
Q

Epidemiology of gender dysphoria

A

Male to female (MTF) > female to male (FTM)

25
Q

Aetiology + pathophysiology

A
  • Primary cause not understood

* Most report gender dysphoria present from early childhood

26
Q

CFs gender dysphoria

A

Co-morbidities → self-harm, suicide, genital mutilation (rare), ↑ risk of STDs/HIV (as MTF more likely to work in sex industry), depression, personality disorder, anorexia, OCD

27
Q

DDx gender dysphoria

A
  • Transvestism
  • Fetishistic transvestism
  • Dual role transvestism
  • Dysmorphobia
  • Schizophrenia
  • Intersexed condition (ruled out by karyotyping)
28
Q

Dx gender dysphoria

A
  • Transsexual identitiy present >2yrs
  • No symptom of another mental disorder
  • OR associated with any intersex, genetic or chromosomal abnormality
29
Q

Rx gender dysphoria

A

Assessment (establish diagnosis w/ certainty):
o Hx + examination
o Weight/BMI, clotting, FSH, LH, sex hormone binding globulin, testosterone, dihydrotestosterone, oestradiol, prolactin, lipid profile….etc
o Information from families, friends, employers…etc

Real life test: one year prior to consideration of surgery pt live full time + attempt to find employment in new sex:
• Hormones
o MTF → synthetic oestrogen (ethinylestradiol) + anti-androgen (finasteride)
o FTM → testosterone

Surgery (sex reassignment)

Legal: change of birth certificate

30
Q

The primary and secondary sex characteristics men

A

PRIMARY: penis and scrotum
testes (maturation during puberty)

SECONDARY: enlargement of the genitalia
lowering of voice pitch
redistribution of muscle tissue and fat
pubic, facial, body and armpit hair

31
Q

The primary and secondary sex characteristics women

A

PRIMARY: vagina and other internal genitalia
vulva and other external genitalia
ovaries (maturation during puberty)

SECONDARY: enlargement of the genitalia
development of the breasts
pubic and armpit hair

32
Q

Define Disorders of sexual preference

A

Disorders of sexual preference (paraphilias) = disorders which an individual is sexually aroused by inappropriate stimuli

33
Q

ICD 10 Disorders of sexual preference

A
  1. Fetishism → non-living objects (e.g. rubber, shoes, clothing)
  2. Fetishistic transverstism → cross-dressing
  3. Exhibitionism → exposure of genitals to strangers
  4. Voyeurism → watching others who are naked, disrobing, or engaging in sexual acts
  5. Paedophilia → children
  6. Sadomasochism → being humiliated, beaten, bound, made to suffer
  7. Other: necrophilia, zoophilia, urophilia…etc
34
Q

Treatment disorders sexual preference

A
  • Don’t treat someone who doesn’t want it
  • Psychodynamic psychotherapy
  • CBT

Behavioural Problems - Psychiatry (6 decks)

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